Randomized Controlled Trial of Icodextrin versus Glucose Containing Peritoneal Dialysis Fluid

Abstract

Background and objectives: While peritoneal dialysis with icodextrin is commonly used in patients with poor peritoneal membrane characteristics, the data on the usefulness of this solution in patients with lower transport characteristics are limited. The study was designed to compare icodextrin to glucose in Chinese prevalent peritoneal dialysis patients of different peritoneal transport characteristics (PET) categories.Design, setting, participants, & measurements: This was a randomized, double-blind, perspective control study. Stable prevalent continuous ambulatory peritoneal dialysis (CAPD) patients were randomized to either 7.5% icodextrin (ICO) or 2.5% glucose (GLU) solution for 4 wk. Peritoneal membrane function was measured to define PET category in baseline. Creatinine clearance (Ccr), urea nitrogen clearance (C BUN ), ultrafiltration (UF) during the long night dwell, dialysate, and metabolic biomarkers were measured at baseline, 2, and 4 wk. UF, Ccr, and C BUN were compared among different PET categories.Results: A total of 201 CAPD patients were enrolled in the study. There were no baseline differences between the groups. Following 2 and 4 wk of therapy, Ccr, C BUN, and UF were all significantly higher in the ICO versus the GLU group. Additionally, switching to ICO resulted in a significant increase in UF in high, high-average, and low-average transporters as compared with baseline. The extent of increased UF was more obvious in higher transporters. Blood cholesterol level in the ICO group decreased significantly than that in the GLU group.Conclusion: Compared with glucose-based solution, 7.5% icodextrin significantly improved UF and small solute clearance, even in patients with low-average peritoneal transport.

Comparison of Icodextrin and Glucose Solutions for Long Dwell Exchange in Peritoneal Dialysis: A Meta-Analysis of Randomized Controlled Trials

“…It is becoming increasingly clear that one of the primary responsibilities of clinicians in the management of PD patients is the balance between adequate control of fluid status and preservation of residual renal function. Numerous clinical studies (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(35)(36)(37) and more than 9 years of post-marketing surveillance have confirmed that icodextrin is a safe and well-tolerated osmotic alternative PD solution to glucose. The most significant adverse effect reported to date is a cutaneous hypersensitivity reaction (38,39).…”

A Meta-Analysis of Icodextrin versus Glucose Containing Peritoneal Dialysis in Metabolic Management of Peritoneal Dialysis Patients

“…Four studies had different dwell times in peritoneal cavity (8-16 h), which could impact the plasma glucose too. The patients in the studies by Lin et al, 3 Paniagua et al, 14 and Bredie et al 17 were in CAPD, and the patients in the study by Posthuma et al 9 were in CCPD. But, even though we excluded the study by Posthuma 9 in which the patients were in CCPD, there was no significant difference in fasting plasma glucose between the two groups.…”

“…18 High glucose concentration solutions could cause insulin resistance and dyslipidemia, which were extremely common in PD patients, and potentially had an impact on cardiovascular outcome. 19 Many studies 3,16,17,20 demonstrated that the ICO could improve the lipid metabolism. In our meta-analysis, we found that the ICO did not have statistically significantly lower blood triglycerides than the GLU, but had the different conclusion in blood total cholesterol.…”

“…No heterogeneity was observed among the trials (p = 0.51; I 2 = 0%). The result did not change when the work of Aiwu, 3 which did not use APD, was excluded (WMD = 0.48; 95% CI = 0.27-0.68; Z = 4.58; p < 0.00001).…”

Novel Peritoneal Dialysis Solutions – What Are the Clinical Implications?

“…However, a recent randomized, double-blind study from China in 201 prevalent CAPD patients compared the effect of either 7.5% icodextrin or 2.5% glucose solution for 4 weeks and reported improved small solute clearance and better UF with icodextrin. Interestingly, the increase in UF occurred across all PET transport groups, indicating that icodextrin can also be used in patients with fluid overload who have low or low-average transport status [41]. …”